Inquiry Form

Inquiry Form
Please complete this form when making enquiries about utilizing the Core. The form can be completed on your computer
and submitted electronically as an email attachment or can be completed by hand and faxed to us. We look forward to
working with you.
To:
Alejandra Villadiego
Email: [email protected]
Phone:
1-212 -305-2643
Fax:
1-212 -305-2518
From:
PI:
Dept:
Project:
Phone:
Fax:
Email:
Date:
Study Details:
Service Type:
DNA Isolation
Cell Culture
Analysis
Serum Storage
DNA Storage
Cell Line Storage
Isolation & Storage of Buffy Coats
Plasma Storage
Estimated Number of Samples:
Type of specimen:
Bloods
Length of Study:
Saliva
Buccal Swabs
Other
Brief description of Study:
Funding Type:Federal Grant
If Grant based, please provide dates:
Special Considerations:
Please note that fees are negotiable and that each case will be judged on its own merits.
Thank you for your interest in the Human Genetics Resources Core.
Rev 03/02/2006